Why the study?
Indications for an additional ICD in patients receiving CRT remain controversial and lack guideline recommendations due to a lack of evidence from randomized controlled trials.
Does cardiac resynchronization therapy with defibrillator (CRT-D) reduce all-cause mortality compared to CRT-P in heart failure patients?
Does cardiac resynchronization therapy with defibrillator (CRT-D) reduce all-cause mortality compared to CRT-P in heart failure patients?
Adding an ICD to CRT reduces all-cause mortality in heart failure patients, though the benefit may not extend to those ≥75 years or with non-ischemic cardiomyopathy.
Answers are grounded in this paper and cite their sources.
May support CRT-D over CRT-P for mortality reduction in select HF patients; leaves open benefit in those ≥75 years or with NICM.
BACKGROUND: Current guidelines did not provide recommendations on indications of an additional implantable cardioverter-defibrillator (ICD) to patients receiving cardiac resynchronization therapy (CRT), and it still remains controversial due to lack of evidence from randomized controlled trials. METHOD: PubMed, Embase, and Cochrane CENTRAL from the inception to May 2020 were systematically screened for studies reporting on the comparison of cardiac resynchronization therapy with defibrillator (CRT-D) and cardiac resynchronization therapy with pacemaker (CRT-P), focusing on the adjusted hazard ratio (aHR) of all-cause mortality. We pooled the effects using a random-effect model. CONCLUSION: After adjusted the differences in clinical characteristics, additional ICD therapy was associated with a reduced all-cause mortality in patients receiving CRT. However, our work suggested that additional ICD may not be applied to elderly (≥75 years) or patients with NICM.
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Long et al. (2020) studied this question.
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